Provider Demographics
NPI:1952359804
Name:WILLIAMS, MONIQUE J (DDS)
Entity Type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:J
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MONIQUE
Other - Middle Name:JOHNETTE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2 RAGON LN
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-3155
Mailing Address - Country:US
Mailing Address - Phone:864-351-2400
Mailing Address - Fax:864-351-2420
Practice Address - Street 1:1 MEMORIAL MEDICAL DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4407
Practice Address - Country:US
Practice Address - Phone:864-351-2400
Practice Address - Fax:864-351-2420
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC40861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice